On March 19, 2020, exactly 20 days after the confirmation of the first Covid-19 case in sub-Saharan Africa, the director of the WHO declared that Africa should “expect the worst”. This assertion was based on the observation that the state of the health systems of African countries would not make it possible to respond effectively to the pandemic. To date, however, the African continent accounts for just 2% of confirmed cases worldwide, and less than 1% of deaths. Even if the limitation of the number of tests does not allow to estimate the prevalence of the disease in Africa, these statistics call into question alarmist and apocalyptic forecasts of a devastating effect of the pandemic in the continent, in particular in its sub-Saharan part.
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Covid-19: a pandemic linked to the age structure of populations
Data from the first affected countries showing a lethality of the disease concentrated in people aged at least 60 years and a virtual absence of mortality in people under 20 years, demographers have hypothesized a differential evolution of the pandemic according to the age structure of the populations. This suggested that with a population with a median age of 18.7 years, a life expectancy at birth of 60.5 years and a proportion of people over the age of 60 of only 4.8%, the pandemic would have a low incidence in Africa.
However, this potential asset of his youth was systematically defeated with the postulate that the endemics affecting the continent like malnutrition, malaria, HIV and tuberculosis, by the decline in immunity which they induce, increase necessarily the vulnerability of African youth to Covid-19
While the predictions of a late onset of the disease on the continent persist, the empirical data collected on the Covid-19 in Burkina Faso help to evolve the debate on the particular progression of the disease that is observed there.
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What is the relationship between age and the spread of Covid-19 in Burkina Faso?
Our current study (“The effect of age on the fatality rate of Covid-19 in Burkina Faso” by Madeleine Wayack Pambè, Bruno Lankoande and Seni Kouanda) highlights the effect of age on the fatality rate of Covid-19 in Burkina Faso. The country registered its first Covid-19 case on March 9, 2020. As of May 17, it had 806 positive cases (including 508 men and 298 women) and 52 deaths. Like the rest of the sub-Saharan subcontinent, the country’s population is young, with an estimated median age of 17.6 years and a life expectancy at birth of 60.9 years.
In accordance with what is observed in Western countries, the risks of hospitalization and lethality due to Covid-19 are closely linked to age in Burkina Faso. Out of 604 positive cases (including 50 deaths) analyzed, 1.8% were under 20 years of age, and no death had been recorded in this population.
Most of the deaths (66%) occurred in people aged 60 and over. The average age increases with the severity of the disease. It is 40 years among non-hospitalized patients, 50 years among hospitalized patients, and 64 years among deceased persons. We note that the average age of deceased people is much lower than that observed elsewhere – 81 years in Italy and 79 years in France for example. It thus reflects the mortality structure of the country, which counts few people living beyond 64 years. Preliminary statistical analyzes show that the effect of age on the lethality of Covid-19 remains decisive, after control by known risk factors for the disease including gender and cardiovascular diseases including hypertension, diabetes and kidney disease.
By limiting the analysis to those hospitalized, for whom the risk factors are available, we observe a lethality five times higher in people aged over 60 years, compared to those under 40 years. The difference in lethality between those under 40 and the 40-59 age group is modest. Diabetes and cardiovascular disease are also risk factors, but an analysis by age group indicates that their effects are more visible in the 40-59 year age group. Overall, therefore, age is the most determining factor in the lethality of Covid-19 in Burkina Faso.
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The youth of its population: a solid bulwark against the Covid-19 in Africa
The first data analyzed from Covid-19 in Burkina Faso thus confirm that the age patterns of the lethality of this disease do not differ from those of Western countries. Despite the absence of serological data making it possible to know the prevalence of the disease in the general population, it can be argued that with contagiousness equal to that of Europe, the African populations, which have few elderly people, develop fewer cases symptomatic and severe and, consequently, experience fewer deaths.
The comorbidity factors – the presence of other diseases or pathologies in addition to the initial disease – particulars envisaged for the continent do not contribute to the spread of the disease either. Malaria and malnutrition (undernutrition) mainly affect children under the age of 5 who are only very unlikely to be infected with Covid-19. Furthermore, the evolution of the pandemic in certain African countries very affected by HIV and tuberculosis such as South Africa seems to indicate that progress in the treatment of patients means that these countries are not particularly more “at risk” “
If Africa is to pay a heavy health price for the pandemic, it will certainly be due to other indirect effects, such as the reduction in the use of health care and the relaxation of certain policies in favor of maternal and child health. ‘child. For the moment, it is holding up better, thanks in large part to the age structure of its population, which is mainly made up of young people.
* Madeleine Wayack-Pambè is a teacher-researcher in demography at Joseph Ki-Zerbo University.
** Bruno Yempabou Lankoande is a researcher in demography (National Institute for Demographic Studies – INED) at Joseph Ki-Zerbo University.
*** Seni Kouanda is a professor of epidemiology at the African Institute of Public Health.